Skip to main content
Log in

Komplikationen des refraktiven Linsenaustausches

Complications after refractive lens exchange

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Im vorliegenden Artikel werden spezifische Komplikationen nach refraktivem Linsenaustausch (RLA) vorgestellt. Das gesamte Komplikationsspektrum des RLA entspricht weitgehend dem der Kataraktchirurgie; im Unterschied zur Kataraktchirurgie werden jedoch beim RLA besonders kurze oder besonders lange Augen behandelt und das Durchschnittsalter der Patienten ist deutlich geringer. Es werden vor dem Hintergrund dieser Sondersituation in dem vorliegenden Artikel speziell das Risiko von Netzhautpathologien nach myopem RLA erörtert und beim hyperopen RLA typische, durch das kurze Vordersegment bedingte, operative Schwierigkeiten dargestellt. Moderne Kleinschnittchirurgie mit Verwendung faltbarer Intraokularlinsen und scharfer Kantenstruktur zur Reduzierung einer Nachstarbildung zusammen mit einem optimalen postoperativen Management können einer Minimierung RLA-spezifischer Komplikationen Rechnung tragen. Zusammenfassend ist der RLA zur Korrektur hoher Ametropien in der presbyopen Altersgruppe derzeit trotz einer geringen Komplikationsrate eine sichere und effektive refraktive Therapieoption.

Abstract

This overview discusses specific complications after refractive lens exchange (RLE). The complication spectrum is similar to that following cataract surgery, with some differences: RLE is implemented in very short or very long eyes, and the average patient age is significantly lower. Regarding specific situations, this article particularly considers the risks of retinal pathologies after myopic RLE and reviews the typical intraoperative difficulties induced by a short anterior segment in hyperopic RLE. Modern microincisional surgery and the use of foldable intraocular lenses with a sharp edge design reduce posterior capsule opacification and, together with optimal postoperative management, may reduce RLE-specific complications. In summary, despite the minor complication rate, RLE for the correction of high ametropias in the presbyopic age group is a safe and effective refractive treatment option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Fukala V (1890) Behandlung der höchstgradigen Myopie durch Aphakie. Graefes Arch Ophthalmol 36: 230–244

    Article  Google Scholar 

  2. Fischer E (1899) Operation der Kurzsichtigkeit und Ablösung der Netzhaut. Centralbl Augenheilkd 23: 79

    Google Scholar 

  3. Fröhlich C (1899) Über spontane und postoperative Kurzsichtigkeitsnetzhautablösungen. Arch Augenheilkd 38: 11–26

    Google Scholar 

  4. Kohnen T, Knorz MC, Neuhann T (2007) Evaluation and quality assurance of refractive surgery procedures by the german ophthalmological society and the professional association of german ophthalmologists. Ophthalmologe 104(8): 719–726

    Article  PubMed  CAS  Google Scholar 

  5. Kohnen T, Wang L, Friedman N, Koch D (2004) Complications of Cataract Surgery. In: Ophthalmology 2nd edition

  6. Patwardhan A, Rao GP, Saha K, Craig EA (2006) Incidence and outcomes evaluation of endophthalmitis management after phacoemulsification and 3-piece silicone intraocular lens implantation over 6 years in a single eye unit. J Cataract Refract Surg 32(6): 1018–1021

    Article  PubMed  Google Scholar 

  7. Results of the Endophthalmitis Vitrectomy Study (1995) A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol 113(12): 1479–1496

    Google Scholar 

  8. Lundstrom M, Wejde G, Stenevi U et al. (2007) Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation to incision type and location. Ophthalmology 114(5): 866–870

    Article  PubMed  Google Scholar 

  9. (2007) Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 33(6): 978–988

  10. Ceschi GP, Artaria LG (1998) Clear lens extraction (CLE) for correction of high grade myopia. Klin Monatsbl Augenheilkd 212(5): 280–282

    Article  PubMed  CAS  Google Scholar 

  11. Gabric N, Dekaris I, Karaman Z (2002) Refractive lens exchange for correction of high myopia. Eur J Ophthalmol 12(5): 384–387

    PubMed  CAS  Google Scholar 

  12. Guell JL, Rodriguez-Arenas AF, Gris O et al. (2003) Phacoemulsification of the crystalline lens and implantation of an intraocular lens for the correction of moderate and high myopia: four-year follow-up. J Cataract Refract Surg 29(1): 34–38

    Article  PubMed  Google Scholar 

  13. Speaker MG, Guerriero PN, Met JA et al. (1991) A case-control study of risk factors for intraoperative suprachoroidal expulsive hemorrhage. Ophthalmology 98(2): 202–209; discussion 10

    PubMed  CAS  Google Scholar 

  14. Kim HK, Shin JP (2008) Capsular block syndrome after cataract surgery: clinical analysis and classification. J Cataract Refract Surg 34(3): 357–363

    Article  PubMed  Google Scholar 

  15. O’Grady RB (1971) Nanophthalmos. Am J Ophthalmol 71(6): 1251–1253

    Google Scholar 

  16. Polkinghorne PJ, Craig JP (2004) Northern New Zealand Rhegmatogenous Retinal Detachment Study: epidemiology and risk factors. Clin Experiment Ophthalmol 32(2): 159–163

    Article  PubMed  Google Scholar 

  17. Perkins ES (1979) Morbidity from myopia. Sight Sav Rev 49(1): 11–19

    PubMed  CAS  Google Scholar 

  18. Grossniklaus HE, Green WR (1992) Pathologic findings in pathologic myopia. Retina 12(2): 127–133

    Article  PubMed  CAS  Google Scholar 

  19. Morita H, Funata M, Tokoro T (1995) A clinical study of the development of posterior vitreous detachment in high myopia. Retina 15(2): 117–124

    Article  PubMed  CAS  Google Scholar 

  20. Celorio JM, Pruett RC (1991) Prevalence of lattice degeneration and its relation to axial length in severe myopia. Am J Ophthalmol 111(1): 20–23

    PubMed  CAS  Google Scholar 

  21. Pierro L, Camesasca FI, Mischi M, Brancato R (1992) Peripheral retinal changes and axial myopia. Retina 12(1): 12–17

    Article  PubMed  CAS  Google Scholar 

  22. Russell M, Gaskin B, Russell D, Polkinghorne PJ (2006) Pseudophakic retinal detachment after phacoemulsification cataract surgery: Ten-year retrospective review. J Cataract Refract Surg 32(3): 442–445

    Article  PubMed  Google Scholar 

  23. Erie JC, Raecker MA, Baratz KH et al. (2006) Risk of retinal detachment after cataract extraction, 1980-2004: a population-based study. Ophthalmology 113(11): 2026–2032

    Article  PubMed  Google Scholar 

  24. Onal S, Gozum N, Gucukoglu A (2004) Visual results and complications of posterior chamber intraocular lens implantation after capsular tear during phacoemulsification. Ophthalmic Surg Lasers Imaging 35(3): 219–224

    PubMed  Google Scholar 

  25. Sharma MC, Chan P, Kim RU, Benson WE (2003) Rhegmatogenous retinal detachment in the fellow phakic eyes of patients with pseudophakic rhegmatogenous retinal detachment. Retina 23(1): 37–40

    Article  PubMed  Google Scholar 

  26. Tielsch JM, Legro MW, Cassard SD et al. (1996) Risk factors for retinal detachment after cataract surgery. A population-based case-control study. Ophthalmology 103(10):1537–1545

    PubMed  CAS  Google Scholar 

  27. Alio JL, Ruiz-Moreno JM, Shabayek MH et al. (2007) The risk of retinal detachment in high myopia after small incision coaxial phacoemulsification. Am J Ophthalmol 144(1): 93–98

    Article  PubMed  Google Scholar 

  28. Alldredge CD, Elkins B, Alldredge OC jr (1998) Retinal detachment following phacoemulsification in highly myopic cataract patients. J Cataract Refract Surg 24(6): 777–780

    PubMed  CAS  Google Scholar 

  29. Arraes J, Diniz JR, Escariao P et al. (2006) Clear lens extraction: visual outcomes and vitreoretinopathy frequence. Arq Bras Oftalmol 69(5): 671–674

    PubMed  Google Scholar 

  30. Barraquer C, Cavelier C, Mejia LF (1994) Incidence of retinal detachment following clear-lens extraction in myopic patients. Retrospective analysis. Arch Ophthalmol 112(3): 336–339

    PubMed  CAS  Google Scholar 

  31. Chastang P, Ruellan YM, Rozenbaum JP et al. (1998) Phacoemulsification for visual refraction on the clear lens. Apropos of 33 severely myopic eyes. J Fr Ophtalmol 21(8): 560–566

    PubMed  CAS  Google Scholar 

  32. Colin J, Robinet A (1994) Clear lensectomy and implantation of low-power posterior chamber intraocular lens for the correction of high myopia. Ophthalmology 101(1): 107–112

    PubMed  CAS  Google Scholar 

  33. Colin J, Robinet A (1997) Retinal detachment after clear lens extraction in 41 eyes with high axial myopia. Retina 17(1): 78–79

    PubMed  CAS  Google Scholar 

  34. Colin J, Robinet A, Cochener B (1999) Retinal detachment after clear lens extraction for high myopia: seven-year follow-up. Ophthalmology 106(12): 2281–2284; discussion 5

    Article  PubMed  CAS  Google Scholar 

  35. Fan DS, Lam DS, Li KK (1999) Retinal complications after cataract extraction in patients with high myopia. Ophthalmology 106(4): 688–91 discussion 91–92

    Article  PubMed  CAS  Google Scholar 

  36. Fernandez-Vega L, Alfonso JF, Villacampa T (2003) Clear lens extraction for the correction of high myopia. Ophthalmology 110(12): 2349–2354

    Article  PubMed  Google Scholar 

  37. Fink AM, Gore C, Rosen ES (2000) Refractive lensectomy for hyperopia. Ophthalmology 107(8): 1540–1548

    Article  PubMed  CAS  Google Scholar 

  38. Fritch CD (1998) Risk of retinal detachment in myopic eyes after intraocular lens implantation: a 7 year study. J Cataract Refract Surg 24(10): 1357–1360

    PubMed  CAS  Google Scholar 

  39. Gris O, Guell JL, Manero F, Muller A (1996) Clear lens extraction to correct high myopia. J Cataract Refract Surg 22(6):686–689

    PubMed  CAS  Google Scholar 

  40. Horgan N, Condon PI, Beatty S (2005) Refractive lens exchange in high myopia: long term follow up. Br J Ophthalmol 89(6): 670–672

    Article  PubMed  CAS  Google Scholar 

  41. Jacobi FK, Hessemer V (1997) Pseudophakic retinal detachment in high axial myopia. J Cataract Refract Surg 23(7): 1095–1102

    PubMed  CAS  Google Scholar 

  42. Jahn CE, Richter J, Jahn AH et al. (2003) Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification. J Cataract Refract Surg 29(5): 925–929

    Article  PubMed  Google Scholar 

  43. Jimenez-Alfaro I, Miguelez S, Bueno JL, Puy P (1998) Clear lens extraction and implantation of negative-power posterior chamber intraocular lenses to correct extreme myopia. J Cataract Refract Surg 24(10): 1310–1316

    PubMed  CAS  Google Scholar 

  44. Kohnen S, Brauweiler P (1996) First results of cataract surgery and implantation of negative power intraocular lenses in highly myopic eyes. J Cataract Refract Surg 22(4): 416–420

    PubMed  CAS  Google Scholar 

  45. Kolahdouz-Isfahani AH, Rostamian K, Wallace D, Salz JJ (1999) Clear lens extraction with intraocular lens implantation for hyperopia. J Refract Surg 15(3): 316–323

    PubMed  CAS  Google Scholar 

  46. Ku WC, Chuang LH, Lai CC (2002) Cataract extraction in high myopic eyes. Chang Gung Med J 25(5): 315–320

    PubMed  Google Scholar 

  47. Lee KH, Lee JH (1996) Long-term results of clear lens extraction for severe myopia. J Cataract Refract Surg 22(10): 1411–1415

    PubMed  CAS  Google Scholar 

  48. Liang D, Chen J (1997) The incidence of retinal detachment after extracapsular cataract extraction in high myopia. Yan Ke Xue Bao 13(2): 90–92

    PubMed  CAS  Google Scholar 

  49. Liesenhoff O, Kampik A (1994) Risk of retinal detachment in pseudophakia and axial myopia. Ophthalmologe 91(6): 807–810

    PubMed  CAS  Google Scholar 

  50. Lyle WA, Jin GJ (1996) Phacoemulsification with intraocular lens implantation in high myopia. J Cataract Refract Surg 22(2): 238–242

    PubMed  CAS  Google Scholar 

  51. Lyle WA, Jin GJ (1997) Clear lens extraction to correct hyperopia. J Cataract Refract Surg 23(7): 1051–1056

    PubMed  CAS  Google Scholar 

  52. Martinez-Castillo V, Boixadera A, Verdugo A et al. (2005) Rhegmatogenous retinal detachment in phakic eyes after posterior chamber phakic intraocular lens implantation for severe myopia. Ophthalmology 112(4): 580–585

    Article  PubMed  Google Scholar 

  53. Nissen KR, Fuchs J, Goldschmidt E et al. (1998) Retinal detachment after cataract extraction in myopic eyes. J Cataract Refract Surg 24(6): 772–776

    PubMed  CAS  Google Scholar 

  54. Pokroy R, Pollack A, Bukelman A (2002) Retinal detachment in eyes with vitreous loss and an anterior chamber or a posterior chamber intraocular lens: comparison of the incidence. J Cataract Refract Surg 28(11): 1997–2000

    Article  PubMed  Google Scholar 

  55. Powell SK, Olson RJ (1995) Incidence of retinal detachment after cataract surgery and neodymium: YAG laser capsulotomy. J Cataract Refract Surg 21(2): 132–135

    PubMed  CAS  Google Scholar 

  56. Pucci V, Morselli S, Romanelli F et al. (2001) Clear lens phacoemulsification for correction of high myopia. J Cataract Refract Surg 27(6): 896–900

    Article  PubMed  CAS  Google Scholar 

  57. Ravalico G, Michieli C, Vattovani O, Tognetto D (2003) Retinal detachment after cataract extraction and refractive lens exchange in highly myopic patients. J Cataract Refract Surg 29(1): 39–44

    Article  PubMed  Google Scholar 

  58. Sheu SJ, Ger LP, Chen JF (2006) Axial myopia is an extremely significant risk factor for young-aged pseudophakic retinal detachment in taiwan. Retina 26(3): 322–327

    Article  PubMed  Google Scholar 

  59. Siganos DS, Siganos CS, Pallikaris IG (1994) Clear lens extraction and intraocular lens implantation in normally sighted hyperopic eyes. J Refract Corneal Surg 10(2): 117–121; discussion 22–24

    PubMed  CAS  Google Scholar 

  60. Siganos DS, Pallikaris IG (1998) Clear lensectomy and intraocular lens implantation for hyperopia from +7 to +14 diopters. J Refract Surg 14(2): 105–113

    PubMed  CAS  Google Scholar 

  61. Tosi GM, Casprini F, Malandrini A et al. (2003) Phacoemulsification without intraocular lens implantation in patients with high myopia: long-term results. J Cataract Refract Surg 29(6): 1127–1131

    Article  PubMed  Google Scholar 

  62. Tsai CY, Chang TJ, Kuo LL et al. (2008) Visual outcomes and associated risk factors of cataract surgeries in highly myopic Taiwanese. Ophthalmologica 222(2): 130–135

    Article  PubMed  Google Scholar 

  63. Uhlmann S, Wiedemann P (2006) Refractive lens exchange combined with pars plana vitrectomy to correct high myopia. Eye 20(6): 655–660

    Article  PubMed  CAS  Google Scholar 

  64. Vicary D, Sun XY, Montgomery P (1999) Refractive lensectomy to correct ametropia. J Cataract Refract Surg 25(7): 943–948

    Article  PubMed  CAS  Google Scholar 

  65. Wang J, Shi Y (2001) Clear lens extraction with phacoemulsification and posterior chamber intraocular lens implantation for treatment of high myopia. Zhonghua Yan Ke Za Zhi 37(5): 350–354

    PubMed  CAS  Google Scholar 

  66. Wang W, Yang G, Nin W, Fang J (1998) Phacoemulsification in myopia and negative or low powered posterior chamber intraocular lens implantation. Zhonghua Yan Ke Za Zhi 34(4): 294–297

    PubMed  CAS  Google Scholar 

  67. Ramos M, Kruger EF, Lashkari K (2002) Biostatistical analysis of pseudophakic and aphakic retinal detachments. Semin Ophthalmol 17(3–4): 206–213

    Google Scholar 

  68. Javitt JC (1994) Clear-lens extraction for high myopia. Is this an idea whose time has come? Arch Ophthalmol 112(3): 321–323

    PubMed  CAS  Google Scholar 

  69. Norregaard JC, Thoning H, Andersen TF et al. (1996) Risk of retinal detachment following cataract extraction: results from the International Cataract Surgery Outcomes Study. Br J Ophthalmol 80(8): 689–693

    Article  PubMed  CAS  Google Scholar 

  70. Javitt JC, Tielsch JM, Canner JK et al. (1992) National outcomes of cataract extraction. Increased risk of retinal complications associated with Nd:YAG laser capsulotomy. The Cataract Patient Outcomes Research Team. Ophthalmology 99(10): 1487–97; discussion 97–98

    PubMed  CAS  Google Scholar 

  71. Baratz KH, Cook BE, Hodge DO (2001) Probability of Nd:YAG laser capsulotomy after cataract surgery in Olmsted County, Minnesota. Am J Ophthalmol 131(2): 161–166

    Article  PubMed  CAS  Google Scholar 

  72. Van Westenbrugge JA, Gimbel HV, Souchek J, Chow D (1992) Incidence of retinal detachment following Nd:YAG capsulotomy after cataract surgery. J Cataract Refract Surg 18(4): 352–355

    Google Scholar 

  73. Skolnick KA, Perlman JI, Long DM, Kernan JM (2000) Neodymium:YAG laser posterior capsulotomies performed by residents at a Veterans Administration Hospital. J Cataract Refract Surg 26(4): 597–601

    Article  PubMed  CAS  Google Scholar 

  74. Dardenne MU, Gerten GJ, Kokkas K, Kermani O (1989) Retrospective study of retinal detachment following neodymium:YAG laser posterior capsulotomy. J Cataract Refract Surg 15(6): 676–680

    PubMed  CAS  Google Scholar 

  75. Koch DD, Liu JF, Gill EP, Parke DW 2nd (1989) Axial myopia increases the risk of retinal complications after neodymium-YAG laser posterior capsulotomy. Arch Ophthalmol 107(7): 986–990

    PubMed  CAS  Google Scholar 

  76. Rickman-Barger L, Florine CW, Larson RS, Lindstrom RL (1989) Retinal detachment after neodymium:YAG laser posterior capsulotomy. Am J Ophthalmol 107(5): 531–536

    PubMed  CAS  Google Scholar 

  77. Behrendt S, Giess L, Duncker G (1991) Incidence of retinal detachment after treatment with the Nd:YAG laser. Fortschr Ophthalmol 88(6): 809–811

    PubMed  CAS  Google Scholar 

  78. Ranta P, Kivela T (1998) Retinal detachment in pseudophakic eyes with and without Nd:YAG laser posterior capsulotomy. Ophthalmology 105(11): 2127–2133

    Article  PubMed  CAS  Google Scholar 

  79. Ranta P, Tommila P, Immonen I et al. (2000) Retinal breaks before and after neodymium:YAG posterior capsulotomy. J Cataract Refract Surg 26(8): 1190–1197

    Article  PubMed  CAS  Google Scholar 

  80. Olsen G, Olson RJ (2000) Update on a long-term, prospective study of capsulotomy and retinal detachment rates after cataract surgery. J Cataract Refract Surg 26(7): 1017–1021

    Article  PubMed  CAS  Google Scholar 

  81. Winslow RL, Taylor BC (1985) Retinal complications following YAG laser capsulotomy. Ophthalmology 92(6): 785–789

    PubMed  CAS  Google Scholar 

  82. Rosen E (2006) Risk management for rhegmatogenous retinal detachment following refractive lens exchange and phakic IOL implantation in myopic eyes. J Cataract Refract Surg 32(5): 697–701

    Article  PubMed  Google Scholar 

  83. Oldendoerp J (1989) Retinal detachment following neodymium YAG laser capsulotomy in aphakic and pseudo-aphakic eyes. Klin Monatsbl Augenheilkd 194(4): 234–240

    Article  PubMed  CAS  Google Scholar 

  84. Ober RR, Wilkinson CP, Fiore JV jr, Maggiano JM (1986) Rhegmatogenous retinal detachment after neodymium-YAG laser capsulotomy in phakic and pseudophakic eyes. Am J Ophthalmol 101(1): 81–89

    PubMed  CAS  Google Scholar 

  85. Kanski JJ, Daniel R (1975) Prophylaxis of retinal detachment. Am J Ophthalmol 79(2): 197–205

    PubMed  CAS  Google Scholar 

  86. Bonnet M, Aracil P, Carneau F (1987) Rhegmatogenous retinal detachment after prophylactic argon laser photocoagulation. Graefes Arch Clin Exp Ophthalmol 225(1): 5–8

    Article  PubMed  CAS  Google Scholar 

  87. Colin J, Robinet A (1997) Clear lensectomy and implantation of a low-power posterior chamber intraocular lens for correction of high myopia: a four-year follow-up. Ophthalmology 104(1): 73–77; discussion 7–8

    PubMed  CAS  Google Scholar 

  88. Hardman Lea SJ, Rubinstein MP, Snead MP, Haworth SM (1990) Pseudophakic accommodation? A study of the stability of capsular bag supported, one piece, rigid tripod, or soft flexible implants. Br J Ophthalmol 74(1): 22–25

    Article  Google Scholar 

  89. Gonzalez F, Capeans C, Santos L et al. (1992) Anteroposterior shift in rigid and soft implants supported by the intraocular capsular bag. Graefes Arch Clin Exp Ophthalmol 230(3): 237–239

    Article  PubMed  CAS  Google Scholar 

  90. Fukuyama M, Oshika T, Amano S, Yoshitomi F (1999) Relationship between apparent accomodation and corneal multifocality in pseudophakic eyes. Ophthalmology 106(6):1178–1181

    Article  PubMed  CAS  Google Scholar 

  91. Kohnen T, Kook D, Auffarth GU, Derhartunian V (2008) Use of multifocal intraocular lenses and criteria for patient selection. Ophthalmologe 105(6): 527–532

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T. Kohnen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kook, D., Kampik, A. & Kohnen, T. Komplikationen des refraktiven Linsenaustausches. Ophthalmologe 105, 1005–1012 (2008). https://doi.org/10.1007/s00347-008-1829-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-008-1829-5

Schlüsselwörter

Keywords

Navigation